Community and health system approaches improves mental health in Afghanistan

"Treatment of mental disorders within the health care system needs to be accompanied by a community-based approach that focuses on psychosocial problems," say the authors of a case study from Afghanistan published in this week's PLoS Medicine as part of the newly launched series on global mental health practice.

A team of health practitioners and researchers from Afghanistan and the Netherlands, led by Peter Ventevogel from the non-governmental organization HealthNet TPO based in Amsterdam, report on their efforts to integrate mental health into the health care system in the eastern province of Nangarhar, Afghanistan, home to 1.38 million people.

The authors explain the context: "After the fall of the Taliban, the rebuilding of the Afghan health care system from scratch, provided opportunities to integrate mental health into basic health services through the use of funds that became available during this complex humanitarian emergency."

The authors report how practice-oriented mental health training for general health workers and ongoing clinical supervision in the basic health care system led to substantially increased demand for and access to basic mental health care services: Since the start of the programme in 2002, 334 doctors, 275 nurses and midwives, and 931 community health workers received basic mental health training and more than 500 community health workers and 300 teachers were trained in stress management and issues relating to domestic violence. As a result, since 2002, the number of consultations for mental health, neurological and substance abuse has increased from 659 to 20 000.

However, the authors faced many challenges including less time to deal with patients due to the huge increase in the number of patients and argue that their programme also demonstrated the need for concurrent community-based approaches, capacity building, and policy development in the health system.

They say: "Addressing service delivery needs in a fragile state has to be accompanied by capacity building and policy development in order to foster structural changes within the health care system."

The authors also admit that they have learned the importance of addressing psychosocial problems through activities outside the formal health care sector to strengthen self-help and foster resilience.